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NURSING HOME REFORM NEWSLETTER

Nov. 17, 2005


NEW MEDICAID REGULATIONS WILL NOT AFFECT
PEOPLE IN NURSING HOMES NOW

According to the state official who engineered an overhaul of Kentucky’s Medicaid program, people who are in nursing homes now will not be affected by the new regulations expected to be approved by the feds soon. Mark Birdwhistell, deputy undersecretary in the Cabinet for Health and Family Services, told us yesterday that "It won’t affect the people who are in a nursing home now." Note that he said, "now." But he quickly added that in the future there will be people who will be judged by the state as not eligible for care paid for by Medicaid in a nursing home. Some of these people will be given Medicaid money to stay in their homes instead of going to a nursing home. He was speaking of what is called the 1115 Waiver that will change a lot of the Medicaid program in the state in an effort to save money. Some nursing home residents were worried that the same thing would happen that did about two years ago when the state began throwing people out of nursing homes to save money. It took a federal court order to stop that. Apparently something like it will not happen this time.

LOOK FOR JAN. 1 START-UP

This new Medicaid program must be approved by the federal government before it can go into effect. Also, the regulations necessary to implement it must be approved by the legislature. The first big step will be taken the last of this month when a state delegation headed by state Medicaid Commissioner Shannon Turner will go to Washington to meet with officials from the Center for Medicare and Medicaid Services. They are expecting CMS to approve the plan that probably will then go into effect around the first of next year. No one has said yet how much money this will save the state that right now has a Medicaid deficit of about $426 million. With the new Medicaid regulations, the example is given that a person can be kept in their home for $25,000 a year where it costs much more than that in a nursing home.

NURSING HOMES ARE QUIET, SO FAR

We haven’t heard much out of the nursing home industry on this new Medicaid program that in the long run could take away a lot of their customers. People eligible for Medicaid will be staying in their homes, if they can. No one wants to go to a nursing home. Eventually you might see nursing homes with only a 50 percent occupancy rate and some of the little ones close or merged with big corporate nursing home companies. Or, nursing homes may turn to assisted living which is the big seller now in long-term care. Of course the aging baby boomers may fill us nursing homes all over again... So the question is this: There always will be people who must have institutional care, and Medicaid will pay for many of them. But will nursing homes offer them quality care? Will they hire enough staff? Lots of things going on, and it will behoove us to keep a close watch.

‘NO PLACE LIKE MY HOME’

With the federal government ready to let Kentucky use Medicaid dollars to take care of people in their homes, you are seeing a lot of people getting on the bandwagon. Kentucky AARP has been pushing "person centered" care for several years now and even got a pilot program started on it by the state. Now comes the senior citizen centers. They want more money to improve the programming in their senior citizens centers, about half of which comes from the state and federal government. Mary Crawley-Schmidt of the Bluegrass Area Agency on Aging and Bert Sisk of Frankfort, chairman of the state Special Advisory Commission of Senior Citizens, told a legislative committee that they are starting a statewide campaign to get more funding called, "There’s No Place Like My Home. "Right now," said Ms. Crawley-Schmidt, "there’s a 15-year wait for some of our services." To which Rep. Kathy Stein pondered out loud: "That means that some of us better get on the list now."

MEDICAID CUTS BEING DEBATED IN WASHINGTON

While state officials are scrambling to cut Medicaid, the same thing is happening in Washington. It’s all a part of the omnibus federal budget bill. And here’s a warning on all that from the National Citizens Coalition for Nursing Home Reform:

"The focus now is on the House... The House bill, with $11 billion in Medicaid cuts that affect real people, is terrible for the poor and for nursing home residents who need Medicaid. It would force residents to account for all their expenditures for five years to qualify for Medicaid. If they could not prove that they had not given away assets – even gifts to help family members or charities – they would be denied Medicaid until they had spent an equivalent amount on their nursing home care. (Supporters of the bill say hardship waivers would protect the truly needy, but the hardship waiver provision has no teeth.) The bill would also whittle away at spousal and family protections in current law."

QUOTE OF THE MONTH...

"The dated notion of ‘Medicaid millionaires’ giving away their money and draining the system was debunked last month in a report by the Health Policy Institute at Georgetown University. After an analysis of several federal studies, the report, written by Ellen O’Brien, found that people qualifying for Medicaid gave gifts of less than $5,000 on average, with a minimal impact on the program." – From a story written by Jane Gross in the June 27 issue of The New York Times.

REP. CHANDLER CO-SPONSORS STAFFING BILL

Rep. Ben Chandler, D-Ky., is once again a co-sponsor of a bill in the House that would set up minimum staffing standards for nursing homes nationwide. Mr. Chandler is one of 41 co-sponsors of H.R. 4293 introduced last week by Rep. Henry Waxman, D-Calif. There are no other co-sponsors yet from Kentucky. WHAT YOU CAN DO:

If you are a constituent of Mr. Chandler, write him an e-mail expressing your appreciation of his support of nursing home reform; and if you are a constituent of one of the other Kentucky congressmen, write to urge their support.

A CNA WRITES THE LEGISLATORS

A CNA working in a Kentucky nursing home sent us a copy of a letter she sent to all the state legislators. We don’t use her name because we would worry that in doing so we could jeopardize her job. Here is the letter:

Dear Sirs,
I realize that House Bill 208 (on establishing minimum staffing ratios for front-line caregivers in nursing homes) was not passed in the 2005 session, but maybe it or a similar one will be put in front of you at the next session. Before you vote NO on it you should give great consideration to what the staffing requirements in a nursing home are at present and how many of us will most likely end up in one.

I am currently employed in a nursing home as a CNA and I
know that this is one of the few states that does not have regulations on staffing requirements. What it says it that there must be "adequate" staffing. Now what a nursing home and what I feel are "adequate" staffing are two totally different ideas. A nursing home is going to use the least number of people to staff a home as possible to increase their profits.

The nursing home that I work for believes that from 6 a.m. till 10 a.m. two CNA's or NA's (nursing assistants) are adequate staffing on a Total Care Unit for 24 residents. Then on the same unit at 10 p.m. till 6 a.m. 2 CNA's or NA's are sufficient for 48 of those Total Care residents. And some shifts those numbers are not met. Speaking from experience with those kinds of ratios you can give marginal care to the residents at best. For those of you who do not know what Total Care means, it is a person that cannot do any of their daily living activities (brush their teeth or hair, get up from a seated position or walk on their own without personal assistance, etc.)

People wonder how abuse can happen in a controlled setting like that, and let me tell you that I could see how it could happen. When you are working under those types of conditions the Pope’s patience or even Job's would be tried and it would be quite easy to lose your composure.

There needs to be some kind of guidelines set up for facilities that take care of our most needy and forgotten assets, our elderly. We would not let places that take care of our children have guidelines that state "adequate" staffing, so why are we doing it to the generations that raised us?

Our elderly are so special and they need much love and caring. A lot of them just need someone to talk to them to make their day. Just someone to take a little time out for them. When you have staffing like I spoke of, you can barely get the things that are necessary done let alone have time to sit down to talk to someone that you care for. And in my eyes there is something very WRONG about that.

Think about where your parents are right now. Do you have them in a
nursing home? What is going to become of you when you get too old or too frail to take care of yourself? Will you be in a nursing home?

Do all of us in this state a favor and support bills like House Bill 208 that mandates staffing requirements in long-term care facilities. It not only will be a blessing to the wonderful older generation of people that I currently have the pleasure of taking care of, it could be a blessing to YOU in the long run.

Thank you for your time,
(Name withheld)

TELL YOUR STORY

One of the biggest problems we encounter in Frankfort is getting the lawmakers to understand the problems in long-term care, particularly the shortage of front-line caregivers. The reason is that unless you have been in a nursing home, or had a loved-one in one, then you really cannot comprehend the lack of care encountered so many times. Many lawmakers have not seen close-up a person lying in a pool of their own urine because there was not enough nurses aides to answer their call bells. WHAT CAN YOU DO? You can tell us your stories and we will pass them on to key legislators. Just send your own stories to me at KyNursingHomeReform@yahoo.com I and I will use them in this newsletter and pass others on to key legislators.

CONFLICTS OF INTEREST

The Nashville Tennessean newspaper last month had a big investigative piece on lobbyists down there sitting on state boards, which the newspaper said could be a conflict of interest. We took a look at the nursing home industry lobbying organizations in Kentucky and found that they have five – which is half – of the voting members on the Kentucky board that licenses nursing home administrators. "Any meaningful ethics reform must end the dubious practice of appointing lobbyists to boards and commissions," said Drew Johnson, president of the Tennessee Center for Policy Research, a free-market think tank. Wonder what Kentucky’s ethics commission thinks.....?

ANOTHER QUOTE OF THE MONTH...

"Information is power, and that may be at the core of this new wave of secrecy: People who work for the government are more powerful when they keep information under wraps. But it’s not right. Why would we want to keep secrets from ourselves?" From an editorial in the Nov. 30 Lexington Herald-Leader.

HAPPY HOLIDAYS...

The Nursing Home Ombudsman Agency of the Bluegrass invites you to its Holiday Showcase at Maxwell Place, the home of University of Kentucky President and Mrs. Lee Todd. The beautiful and historic home is located on the UK campus and at Christmastime can be a veritable wonderland. Dates are Nov. 25-27 and Dec. 2-4 from 10 to 4 on Fridays and Saturdays and 12-5 on Sundays. Tickets are $10 per person. (I have had the privilege of seeing beautiful and historic Maxwell Place decorated at Christmastime and it is something to behold. This is an event you don’t want to miss for a very good cause.)
 

P.S.

Why Men Are Just Happier People

What do you expect from such simple creatures?

Your last name stays put.

The garage is all yours.

Wedding plans take care of themselves.

Chocolate is just another snack.

You can be president.

You can never be pregnant.

You can wear a white T-shirt to a water park.

You can wear NO T-shirt to a water park.

Car mechanics tell you the truth.

The world is your urinal.

You never have to drive to another gas station restroom because this one is just too icky.

You don't have to stop and think of which way to turn a nut on a bolt.

Same work, more pay.

Wrinkles add character.

Wedding dress: $5000. Tux rental: $100.

People never stare at your chest when you're talking to them.

The occasional well-rendered belch is practically expected.

New shoes don't cut, blister, or mangle your feet.

One mood - all the time.

Phone conversations are over in 30 seconds flat.

You know stuff about tanks and guns.

A five-day vacation requires only one suitcase.

You can open all your own jars.

You get extra credit for the slightest act of thoughtfulness.

If someone forgets to invite you, he or she can still be your friend.

Your underwear is $8.95 for a three-pack.

Three pairs of shoes are more than enough.

You almost never have strap problems in public.

You are unable to see wrinkles in your clothes.

Everything on your face stays its original color.

The same hairstyle lasts for years, maybe decades.

You only have to shave your face and neck.

You can play with toys all your life.

Your belly usually hides your big hips.

One wallet and one pair of shoes, one color for all seasons.

You can wear shorts no matter how your legs look.

You can "do" your nails with a pocketknife.

You have freedom of choice concerning growing a mustache.

You can do Christmas shopping for 25 relatives on December 24 in 45 minutes.

No wonder men are happier!

-- From my good friend Alice Dehner.

DON’T FORGET...

MORE THAN 30,000 PEOPLE IN NURSING HOMES IN KENTUCKY NEED US. THEY ARE KENTUCKY’S FORGOTTEN PEOPLE.